Classifications of Prominent Mandibular Angle and Surgical Considerations for Mandibuloplasty.

Contouring surgery is an operation that makes a smooth, oval-shaped face by removing protruding parts of the face. In particular, mandibuloplasty is a procedure that softens the shape of the mandible and is a popular procedure among Asians with a dominant mesocephalic profile. In this study, we tried to discuss the considerations before surgery by dividing the mandibular shape into morphologic aspects in the lateral and frontal views and anatomic considerations. In the lateral view, it is essential to consider the posterior ramal height and mandibular body length of each patient. These factors are closely related to the postoperative outcomes. Consideration of the mandibular plane angle is also essential. In the frontal view, the position of the gonial angle relative to the ramal body should be considered because the position of the gonial angle can affect the difficulty of operation. Anatomic considerations include antero-posterior ramal width, bucco-lingual width of mandibular body, amount of mouth opening, and location of inferior alveolar nerve. These are important factors that determine the difficulty of the operation. In this study, classification according to the shape and shape of the mandible was presented, and considerations for each classification were discussed. Cosmetic surgery is a socio-psychologically meaningful procedure that not only improves the esthetics but also improves the mental well-being of the patients. Therefore, it will be possible to provide better medical services to patients if clinicians are fully aware of the factors that can increase the difficulty of the operation and the factors that affect the surgical outcome.

Treatment Strategy for Condyle/Ramus Deficiency Using 3D Virtual Surgery and CAD/CAM Technologies; Total Joint Replacement or Inverted-L Osteotomy.

OBJECTIVE: To introduce a guideline for selecting proper surgical modalities for correction of skeletal Class II malocclusion with moderate-to-severe vertical height deficiency (VHD) of the condyle/ramus complex (CRC) using bimaxillary surgery in conjunction with total joint replacement (TJR) or inverted-L osteotomy (ILO) assisted by 3D virtual surgical planning and CAD/CAM technologies. CASES: Four cases of severe skeletal Class II patients with moderate-to-severe VHD of CRC were presented. They underwent bimaxillary surgery using Le Fort I osteotomy in the maxilla and TJR or ILO in the mandible, with the help of virtual surgical planning (VSP) and computer-aided design/computer-aided manufacturing (CAD/CAM)-printed surgical guides and osteosynthesis plates. Guidelines are as follows: (1) if a patient has a moderate degree of VHD and the function of the temporomandibular joint (TMJ) is normal, ILO would be preferred for vertical elongation of the ramus; (2) if a patient has congenitally small condyle or severe condylar resorption, TJR would be preferred to resolve severe VHD of CRC; and (3) when a patient has a metal allergy, foreign body reaction or anatomic limitations (ie, thin cranial base cortex for fossa fixation), ILO would be a better option than TJR. RESULTS: TJR or ILO using VSP and CAD/CAM-printed surgical guides, wafers, and customized plates can provide a proper selection of the surgical plan, accurate transfer of surgical plans to actual surgical procedures, and esthetic improvement of the facial profile. CONCLUSION: This guideline based on the degree of VHD and functional aspects of CRC might help clinicians to select effective surgical modality for correction of skeletal Class II malocclusion with moderate-to-severe VHD of CRC.

The Efficacy of 3D Virtual Surgery, CAD/CAM, and 3D Printing Technology for Maxillomandibular Advancement in Obstructive Sleep Apnea Patients.

OBJECTIVE: Maxillomandibular advancement (MMA) is the most effective surgical method for treating obstructive sleep apnea, and it moves the maxillomandibular complex forward to increase the entire upper airway volume. By using 3-dimensional (D) virtual surgery, computer-aided design/computer-aided manufacturing, and 3D printing technologies, it is possible to overcome all the limitations of conventional methods. MATERIALS AND METHODS: In this study, (modified) MMA was performed by applying 3D technologies to obstructive sleep apnea patients. Virtual surgery was done as surgical plan, cutting guides, and customized plates were made by computer-aided design/computer-aided manufacturing and 3D printing technologies for surgical procedures. RESULTS: After surgery, all patients improved their appearance, quality of sleep, and sleep apnea level were dramatically improved. Through these results, it was found that there are many advantages in using 3D technologies for preparing and implementing MMA. CONCLUSIONS: It was confirmed that the accuracy and efficiency of surgery were increased by applying 3D technologies. This suggests that 3D technologies are very useful tools in surgical area.

Causes of Reoperation Consultation and Clinical Review of Actual Reoperation After Previous Orthognathic Surgery.

OBJECTIVE: To investigate the causes of reoperation consultation, and the actual percentage and procedures of reoperation after previous orthognathic surgery. METHODS: The samples consisted of 30 patients who visited our clinic for reoperation consultation from October 2015 to September 2021 (6 males and 24 females; mean age at reoperation consultation, 28.4 y). Patient's causes of reoperation consultation were divided into "esthetic dissatisfaction," "airway changes," "temporomandibular disorders," "uncomfortable occlusion," and "other complications". In terms of esthetic dissatisfaction, the more detailed esthetic problem was evaluated by the clinical chart, facial photographs, and radiographs. In patients who actually underwent reoperation, the actual percentage and procedures of reoperation were investigated. RESULTS: The most prevalent causes for reoperation consultation were "esthetic dissatisfaction" (n = 21, 70.0%), followed by "airway changes" (n = 11, 36.7%), "uncomfortable occlusion" (n = 8, 26.7%), "other complications" (n = 5, 16.7%), and "temporomandibular disorder" (n = 4, 13.3%). Less than half of patients actually underwent reoperation (n = 13, 43.3%). Actual reoperation procedures included minor revision surgery, reconstruction surgery, or complete reoperation according to the patient's need. In case of complete reoperation, more accurate and predictable results were obtained by using virtual surgical planning, customized surgical guides, titanium surgical plates made with computer-aided design and computer-aided manufacturing technique, and a 3-dimensional printing method. CONCLUSION: It is important to communicate with patients about expectations for facial esthetic improvement by orthognathic surgery for obtaining the patient's postoperative satisfaction.

Surgical Accuracy of 3D Virtual Surgery and CAD/CAM-Assisted Orthognathic Surgery for Skeletal Class III Patients.

Orthognathic surgery is an effective surgical method to achieve functionality and facial esthetics for mandibular prognathism. If surgery is performed with a conventional method, errors may occur in the surgical preparation process and the surgical procedures, and there is a limitation in that the accuracy of surgery is determined according to the surgeon's experience and tactual sense. However, with the recent development of three-dimensional (3D) virtual planning and CAD/CAM technology, more 3D and predictable surgical planning and more accurate and time-saving surgery have become possible. The purpose of this study is to evaluate the surgical accuracy of 3D Virtual Surgery, CAD/CAM-Assisted Orthognathic surgery for Skeletal Class III Patients. The study included 18 patients who had undergone orthognathic surgery for skeletal class III malocclusion from January 2020 to December 2021. To evaluate the accuracy of the virtual planning, 3D facial cone-beam computed tomography taken immediately after surgery (T1) and virtual surgery data (Tv) were superimposed in each patient. Landmarks were set on each of the maxillary segment, mandibular distal segment, and left and right mandibular proximal segment, and the difference between T1 and Tv was compared 3D on the x , y , and z -axis. (ΔT: T1-Tv). As a result, the average distance between Tv and T1 at each landmark, all landmarks except for the posterior nasal spine of the maxillary segment showed <1 mm. In particular, the differences across the x and z -axis were very small, while the difference across the y -axis tend to be large. The comparison of the position of each segment in virtual surgery and actual surgery was as follows. It can be seen that all segments were located slightly downward, and the medial pole of the mandibular proximal segment was located posterolateral and the lateral pole was located anteromedial after the actual surgery compared with the virtual planning. It means that the proximal segment was slightly rotated, but the difference was within 1 mm, so it can be considered that the surgery was accurate. Base on this study, orthognathic surgery using 3D virtual surgery planning and CAD/CAM technologies was very accurate. By applying these cutting-edge technologies to clinical practice, it was possible not only to increase the predictability of surgery but also to improve the convenience of surgery. Therefore, it is thought that it will be important for clinicians to make continuous efforts to applicate cutting-edge technologies to be developed in the future to patient diagnosis and surgery.

The Accuracy and Stability of Intentional Change of Frontal-Ramal Inclination in Orthognathic Surgery for Facial Asymmetry Patients.

Facial asymmetry can be defined as differences in the left and right sides of the face, and most of the patients with facial asymmetry have different left and right frontal-ramal inclinations (FRIs). Restoring the symmetry of both FRIs is important in the surgery of facial asymmetry patients, but it is very difficult to achieve perfect symmetry through conventional orthognathic surgery. However, by using 3-dimensional (3D) virtual planning and CAD/CAM technolo gies, intentional change of FRIs can be possible so the symmetry can be improved. The purpose of this study is to evaluate the surgical accuracy and long-term stability of intentional change of FRIs by 3D virtual surgery, CAD/CAM-assisted orthognathic surgery for patients with facial asymmetry. The study included 20 patients who had undergone orthognathic surgery for skeletal class III malocclusion from January 2019 to December 2021. To evaluate the accuracy of surgery, 3D facial cone beam computed tomography (CBCT) taken immediately after surgery (T1) and virtual surgery data (Tv) were measured and the difference values were calculated. The evaluation of the long-term stability of intentional change of FRI was performed by measuring T1 and T2 (3D facial cone beam computed tomography images taken 6 mo after surgery) and the difference values were calculated. The difference values of FRIs in the left and right proximal segments of each patient were calculated. And then, for comparison depending on the direction of rotation, increased FRI groups (n=20, medial rotation) and decreased FRI groups (n=20, lateral rotation) were analyzed separately. As a result, all difference values at both (ΔT1-Tv) and (ΔT2-T1) were <1 degree. As a result of analyzing the entire FRI by dividing it into decreasing and increasing groups, the mean value of (ΔT1-Tv) was 0.225 degrees for the decreasing group and 0.275 degrees for the increasing group. It means that the proximal segment moved less than the movement implemented by the virtual surgery through actual surgery but it shows a very small error, which means that the overall operation almost accurately implements the virtual surgical planning. Compared with (ΔT1-Tv), the mean value of (ΔT2-T1) showed a much smaller error value, and no specific tendency was observed. This indicates that the stability after surgery is very good. Based on this study, using 3D virtual surgery planning and CAD/CAM technologies for treating patients with facial asymmetry was very useful, and surgery could be performed accurately and predictably. In particular, left-right symmetry was almost perfectly achieved through virtual simulation and could be implemented through actual surgery. Therefore, it can be said that the use of these 3D technologies is recommended for the surgical approach of facial asymmetry.

Reduction Malarplasty Using Customized Surgical Stent Based on 3D Virtual Surgery, CAD/CAM, and 3D Printing Technology: Case Series.

ABSTRACT: The zygomatic bone is a structure that protrudes symmetrically on both sides of the midface and plays an important role in the overall aesthetic appearance of the face. Unlike Caucasians, the mesocephalic facial shape is predominant in Asians, and therefore, many people have a relatively laterally developed zygomatic bone. In Asians, when the zygomatic bone is excessively developed, it gives a strong and stubborn image, and aesthetically, many people want to reduce the zygomatic bone because they prefer an oval and slim face.To reduce the excessive zygomatic bone, a reduction malar- plasty through an intraoral and preauricular approach has been performed. Although reducing the zygomatic bone is not a big problem in most cases of symmetric reduction malarplasty, it is not easy to produce surgical results as intended by the surgeon in asymmetric malar patients or patients requiring a three-dimensional (3D) change of zygoma. In addition, because of the mobility of the zygoma segment, it may be difficult to drill holes and fix plate after osteotomy. Moreover, these factors can increase the possibility of malunion or nonunion.In this study, cutting guides made with the aid of 3D virtual surgery, 3D printing, and customized titanium plates manufactured with the computer-aided design/computer-aided manufacturing technology are used for 8 patients to maximize the recovery of 3D symmetry and minimize complications through accurate fixation after surgery. During the surgical procedures, screw hole drilling and osteotomy were performed using a cutting guide, and then, the malar segment was fixed by matching the premade customized plates with the predrilled holes. As a result of checking the accuracy of the surgery by superimposing the postoperative 3D cone beam computed tomography image and virtual surgery data based on the skull base, the 2 images almost overlapped and no significant differences were observed, so it was confirmed that the operation was performed exactly as planned.When using the 3D technology, it is possible to perform a more accurate surgery in patients with asymmetry due to congenital anomalies or trauma as well as simple asymmetry, so it can be concluded that using the 3D technology can overcome the limitations and disadvantages of the conventional method as in the cases in this study. The accurate prediction of soft tissue is still insufficient, and further research is needed to overcome this limitation.

Correction of Midface Deficiency in Patient With Crouzon Syndrome by Orthognathic Surgery and Patient Specific Facial Implant: Case Report.

ABSTRACT: Crouzon syndrome, also known as craniofacial dysostosis, is an autosomal dominant inherited disease characterized by early cranial fusion and consequential craniofacial malformations. In patients with Crouzon syndrome, the growth of the midface is affected due to early fusion of the cranial base, which results in exophthalmos, ocular ptosis, midface deficiency, and maxillary retrognathism. Frontofacial advancement using Le Fort III osteotomy is the conventional method for treating patients with Crouzon syndrome. However, this procedure has drawbacks such as extensive operation field and high possibility of serious complications (eg, meningitis). For patients with mild symptoms, facial esthetics and proper occlusion can be promoted through conventional orthognathic surgery, but midface deficiency cannot be completely resolved. Thus, in this case report, midface augmentation was performed for a patient with Crouzon syndrome by undergoing conventional orthognathic surgery, along with patient-specific implants made using a 3D virtual technique. Implants were 3D printed using polyetherketoneketone and simultaneously implanted during the orthognathic surgery. After the surgery, not only were the patient's occlusion and facial esthetics improved, but also exophthalmos and ocular ptosis were reduced by the midfacial augmentation effect of patient-specific implants placed in the midface. Since the implants were made exactly as what surgeons have intended through computer-aided design (CAD)/computer-aided manufacturing (CAM) and 3D printing techniques, problems such as under-/over-correction were avoided. In addition, the possibility of implant malpositioning was minimized using surgical stents as implants were passively fitted on the patient's bone surface. This case verified that the application of 3D technology to the field of oral and maxillofacial surgery can reduce the invasiveness of surgery and improve the accuracy of the operation. Therefore, by using cutting-edge technologies, the field of oral and maxillofacial surgery is expected to be developed further in the near future.

Restoration of Facial Bone Defect using Patient-Specific Implant.

ABSTRACT: Facial bone defects can be caused by various causes, such as congenital deformities, iatrogenic results, and trauma. If the size of the bone defect is small, it can be repaired using premanufactured products, but it is not accurate and impossible to restore large bony defect. In the effort to overcome these limitations of premanufac-tured implants, the authors use patient-specific implant (PSI) via computer-aided design/computer-aided manufacturing and 3D printing technologies for facial bone restoration surgery. In this study, the authors use polyetherketoneketone and titanium alloy for implant material among various capable of 3D printing. As a result of analyzing the patients who underwent surgery in this study, PSIs were made in 57 sites for 29 patients. The most common reason for surgery was to improve the patient's esthetics (14 cases), followed by the improvement of iatrogenic complications and postoperative dissatisfaction (11 cases). Restoration of the congenital bony defect was the least (4 cases). Postoperative complications were occurred in 5 patients (screw loosening in 1 case, postoperative dissatisfaction in 3 cases, and postoperative infection in 1 case). There is no case of rejection after implant insertion, because the authors use polyetherketoneketone and titanium alloy for implant material which are good biocompatibility. By using PSIs via 3D technologies, the authors can overcome the limitations of premanufactured products. Moreover, the authors could get better results. So these cutting edge technologies can improve our surgical procedures and predictability.

Maxillary Total Elongation Surgery using 3D Virtual Surgery, CAD/CAM and 3D Printing Technology: Surgical Convenience and Accuracy.

After Le Fort I osteotomy was first performed by von Langernbeck in 1859, there has been many improvements since. Research on and development of Le Fort I osteotomy procedure has shown downward movement of the maxilla to exhibit lowest stability and accuracy. However, maxillary downgraft movement is necessary in orthognathic patients with insufficient vertical length of the maxilla, but fixation of the maxilla after elongation is often very inaccurate. In this study, the authors utilized 3D virtual surgery, CAD/CAM-assisted 3D printing technology to overcome such limitations of maxillary total elongation. In addition, accuracy at 7 different landmarks from superimposition of virtual simulation data and postoperative Cone-beam computed tomography (CBCT) data were measured. Although posterior maxilla exhibited bigger range of errors, an error of <1 mm was measured at all 7 landmarks. Operation time was greatly shortened with cutting guides and customized plates. Although this study is a single-case study, this study shows increased accuracy and efficacy from application of 3D virtual surgery, CAD/CAM, and 3D printing technology.

MSM promotes human periodontal ligament stem cells differentiation to osteoblast and bone regeneration.

Periodontal disease is the most common chronic disease of the oral and maxillofacial region, causing alveolar bone loss and ultimate loss of tooth. The purpose of treatment of periodontal disease is to promote the regeneration of periodontal tissue, including alveolar bone, and implantation of fixtures to replace the missing tooth as a result of advanced periodontal disease also requires alveolar bone regeneration. Methylsulfonylmethane (MSM) is a sulfur compound with well-known anti-inflammatory effects but its effects on bone regeneration are unknown. In this study, we investigated the effects of MSM on osteogenic differentiation of human PDLSCs (hPDLSCs) in vitro and in vivo. Our results demonstrate that MSM not only promotes the proliferation but also promotes osteogenic differentiation of hPDLSCs. MSM increased the expression levels of osteogenic specific markers that ALP, OPN, OCN, Runx2, and OSX. Smad2/3 signaling pathway was reinforced by MSM. Runx2, which downstream of Smad pathway, was expressed in accordance. Consistent with in vitro results, in vivo calvarial defect model and transplantation model revealed that MSM induces hPDLSCs to differentiate into osteoblast, which express ALP, OPN and OCN highly and enhance bone formation. These results suggest that MSM promotes osteogenic differentiation and bone formation of hPDLSCs, and Smad2/3 / Runx2 / OSX / OPN may play critical roles in the MSM-induced osteogenic differentiation. Thus, MSM combined with hPDLSCs may be a good candidate for future clinical applications in alveolar bone regeneration and can be used for graft material in reconstructive dentistry.

The relationship between enhanced enzyme activity and structural dynamics in ionic liquids: a combined computational and experimental study.

Candida antarctica lipase B (CALB) is an efficient biocatalyst for hydrolysis, esterification, and polymerization reactions. In order to understand how to control enzyme activity and stability we performed a combined experimental and molecular dynamics simulation study of CALB in organic solvents and ionic liquids (ILs). Our results demonstrate that the conformational changes of the active site cavity are directly related to enzyme activity and decrease in the following order: [Bmim][TfO] > tert-butanol > [Bmim][Cl]. The entrance to the cavity is modulated by two isoleucines, ILE-189 and ILE-285, one of which is located on the α-10 helix. The α-10 helix can substantially change its conformation due to specific interactions with solvent molecules. This change is acutely evident in [Bmim][Cl] where interactions of LYS-290 with chlorine anions caused a conformational switch between α-helix and turn. Disruption of the α-10 helix structure results in a narrow cavity entrance and, thus, reduced the activity of CALB in [Bmim][Cl]. Finally, our results show that the electrostatic energy between solvents in this study and CALB is correlated with the structural changes leading to differences in enzyme activity.

Optimization of lipase-catalyzed synthesis of caffeic acid phenethyl ester in ionic liquids by response surface methodology.

Lipase-catalyzed caffeic acid phenethyl ester (CAPE) synthesis in ionic liquid, 1-ethyl-3-methylimidazolium bis[(trifluoromethyl)sulfonyl]imide ([Emim][Tf(2)N]), was investigated in this study. The effects of several reaction conditions, including reaction time, reaction temperature, substrate molar ratio of phenethyl alcohol to caffeic acid (CA), and weight ratio of enzyme to CA, on CAPE yield were examined. In a single parameter study, the highest CAPE yield in [Emim][Tf(2)N] was obtained at 70 °C with a substrate molar ratio of 30:1 and weight ratio of enzyme to CA of 15:1. Based on these results, response surface methodology (RSM) with a 3-level-4-factor central composite rotatable design (CCRD) was adopted to evaluate enzymatic synthesis of CAPE in [Emim][Tf(2)N]. The four major factors were reaction time (36-60 h), reaction temperature (65-75 °C), substrate molar ratio of phenethyl alcohol to CA (20:1-40:1), and weight ratio of enzyme to CA (10:1-20:1). A quadratic equation model was used to analyze the experimental data at a 95 % confidence level (p < 0.05). A maximum conversion yield of 99.8 % was obtained under the optimized reaction conditions [60 h, 73.7 °C, substrate molar ratio of phenethyl alcohol to CA (27.1:1), and weight ratio of enzyme to CA (17.8:1)] established by our statistical method, whereas the experimental conversion yield was 96.6 ± 2 %.

Effect of ionic liquids on enzymatic synthesis of caffeic acid phenethyl ester.

Although caffeic acid phenethyl ester (CAPE), an active flavonoid, plays an important role in the antioxidant activity of honeybee propolis, the isolation of CAPE from honeybee propolis is time-consuming due to wide variety of impurities present. Therefore, biochemical method to synthesize CAPE was investigated in this study. Since ionic liquids (ILs) possess some unique characteristics as appreciated alternatives to conventional solvents for certain biotransformation, the effect of ILs as reaction media for enzymatic synthesis of CAPE was assessed. Several factors including substrate molar ratio, and reaction temperature affecting the conversion yield of lipase-catalyzed CAPE synthesis were also investigated. Reaction yields were significantly higher in hydrophobic ILs than in hydrophilic ILs (almost zero). Among nine hydrophobic ILs tested, the highest conversion of synthetic reaction was obtained in 1-ethyl-3-methylimidazolium bis[(trifluoromethyl)sulfonyl]imide ([Emim][Tf(2)N]). A reaction temperature of 70 °C was found to give high conversion. In addition, optimal substrate molar ratio between phenethyl alcohol and caffeic acid (CA) was decreased significantly from 92:1 to 30:1 when ILs were used instead of isooctane.

Surgical correction of cleft lip lower-lip deformity: a report of three cases.

Cleft lip lower-lip deformity is a secondary deformity in patients who underwent primary cheiloplasty of the upper lip, characterized by an enlarged and anteriorly rotated lower lip. In these cases, soft-tissue imbalances remain even after skeletal correction with orthognathic surgery, and additional soft tissue treatment is required for lip harmony and esthetic facial balance in CLP (cleft lip palate) patients. This study describes three cases of transverse myomucosal excision of the lower lip for correction of cleft lip lower-lip deformity to restore facial esthetic balance. Each patient underwent orthognathic surgery, rhinoplasty, or upper lip revision cheiloplasty according to condition. Postoperatively, volume of the lower lip decreased and lip harmony was improved in all three patients. The surgeon should fully understand the anatomical structure around the lips and be able to evaluate overall harmony of the soft tissue. When a lower lip deformity is present, careful surgical planning and execution are important for each patient.

Optimization of lipase-catalyzed glucose ester synthesis in ionic liquids.

Lipase-catalyzed esterification of glucose with fatty acids in ionic liquids (ILs) mixture was investigated by using supersaturated glucose solution. The effect of ILs mixture ratio, substrate ratio, lipase content, and temperature on the activity and stability of lipase was also studied. The highest yield of sugar ester was obtained in a mixture of 1-butyl-3-methylimidazolium trifluoromethanesulfonate ([Bmim][TfO]) and 1-methyl-3-octylimidazolium bis[(trifluoromethyl)-sulfonyl]amide ([Omim][Tf(2)N]) with a volume ratio of 9:1, while Novozym 435 (Candida antarctica type B lipase immobilized on acrylic resin) showed the optimal stability and activity in a mixture of [Bmim][TfO] and [Omim][Tf(2)N] with a 1:1 volume ratio. Reuse of lipase and ILs was successfully carried out at the optimized reaction conditions. After 5 times reuse of Novozym 435 and ILs, 78% of initial activity was remained.

Separation characteristics of hydrophilic ionic liquids from ionic liquids-water solution by ultrasonic atomization.

Ionic liquids (ILs) have attracted much attention as promising alternatives for volatile organic solvents. Although the applications of ILs have been found in a diverse range of fields, there are a limited number of methods for the recovery of ILs so far. As an efficient separation method, therefore, ultrasonic atomization has been attempted to recover hydrophilic ILs, [Bmim][BF4], from ILs-water solution. In order to examine the separation characteristics of hydrophilic ILs-water solution, ultrasonic atomization of hydrophilic ILs-water solution was performed under various operating conditions such as initial ILs concentration, ultrasonic electric power, carrier gas flow rate, and operating temperature. The result showed that hydrophilic ILs recovery yield increased with a decrease in ultrasonic electric power, gas velocity, and temperature. As an increase in initial ILs concentration, however, higher ILs recovery yield was obtained. After 6 h of ultrasonic atomization of 50% (v/v) [Bmim][BF4]-water solution, 93.4% of initial ILs amount was recovered without any changes in their structure at ultrasonic power of 10 W, carrier gas flow of 5 L/min and temperature of 20 °C. It demonstrated that ultrasonic atomization could be used for the recovery of ILs from ILs-aqueous solution.

Treatment of severe pain in a patient with complex regional pain syndrome undergoing dental treatment under general anesthesia: A case report.

Complex regional pain syndrome (CRPS) is rare, characterized by pain from diverse causes, and presents as extreme pain even with minor irritation. General anesthesia may be required for dental treatment because the pain may not be controlled with local anesthesia. However, treatment under general anesthesia is also challenging. A 38-year-old woman with CRPS arrived for outpatient dental treatment under general anesthesia. At the fourth general anesthesia induction, she experienced severe pain resulting from her right toe touching the dental chair. Anesthesia was induced to calm her and continue the treatment. After 55 minutes of general anesthesia, the patient still complained of extreme toe pain. Subsequently, two administrations for intravenous sedation were performed, and discharge was possible in the recovery room approximately 5 h after the pain onset. The pain was not located at the dental treatment site. Although the major factor causing pain relief was unknown, ketamine may have played a role.

Lipase-catalyzed synthesis of fatty acid sugar ester using extremely supersaturated sugar solution in ionic liquids.

The low solubility of sugars has hampered the lipase-catalyzed synthesis of fatty acid sugar esters in organic solvents and ionic liquids (ILs), because several solvents that are able to effectively dissolve sugars are detrimental to enzymes. In this work, in order to prepare a high concentration of sugars in ILs, we have developed a new procedure that entails mixing an aqueous sugar solution into ILs followed by removal of the water from the solution. The glucose concentrations in the supersaturated [Emim][TfO] and [Bmim][TfO] were 19 and 10 times higher, respectively, than the solubilities (6.1 and 4.8 g/L) of glucose in the ILs at 25 degrees C. Furthermore, the supersaturated glucose solutions in ILs were maintained over a long period of time without any significant loss of glucose. In ILs that were extremely supersaturated with glucose, lipase-catalyzed esterifications of glucose with vinyl laurate, and lauric acid were successfully carried out. The conversion increased from 8% to 96% at 1 day of reaction by using supersaturated solution in [Bmim][TfO] which had dissolved glucose concentration of 400% higher than its solubility, compared with the reaction using saturated glucose solution. By making the glucose concentration in ILs much higher than the solubility through our novel and simple method, the initial rate and conversion of the lipase-catalyzed reaction were significantly improved.

Lipase-catalyzed synthesis of glucose fatty acid ester using ionic liquids mixtures.

Novozym 435-catalyzed synthesis of 6-O-lauroyl-d-glucose in ionic liquids (ILs) was investigated. The highest lipase activity was obtained in water-miscible [Bmim][TfO] which can dissolve high concentration of glucose, while the highest stability of lipase was shown in hydrophobic [Bmim][Tf(2)N]. The optimal activity and stability of lipase could be obtained in [Bmim][TfO] and [Bmim][Tf(2)N] mixture (1:1, v/v). Specifically, the activity of lipase was increased from 1.1 to 2.9 micromolmin(-1)g(-1) by using supersaturated glucose solution in this mixture, compared with reaction using saturated solution. After 5 times reuse of lipase, 86% of initial activity was remained in this mixture, while the residual activity in pure [Bmim][TfO] was 36%. Therefore, the productivity obtained by using ILs mixtures was higher than those in pure ILs.